MAs supervising RNs and LPNs

[breenzanemom]

HELP! I'm a new clinical manager in a pediatric office (14 providers, 24 RNs, LPNs and Medical Assistants {MAs}). Unfortunately, in the past, the practice has used the MAs as "charge nurses" over the RNs and LPNs. I have tried and tried to explain to the docs in charge and my supervisor that this is not appropriate. I have gotten in touch with the state Board of Nursing, who also said that it is not appropriate. But the docs keep saying "we've always done it that way" and don't want to change now because they feel that some of the MAs are capable of being in charge. So they are accusing me of "not liking" MAs (not true, but I can't go against what my state Board of Nursing or myt Nurse Practice Act says).

They have acquiesced (spelling?) somewhat in agreeing that the LPNs and RNs will be "charge nurses", but they want the MAs to be "Patient flow persons" (or some such title), in that they would direct the flow of patients into the rooms and relay orders from the docs to the RNs and LPNs and other MAs. I am still not comfortable with this, but see no option (aside from quitting, which I really don't want to do).

I want to write up a list of what the "Patient Flow Persons" can do and cannot do, but don't know where to start, because each time I write something down, it has a clinical element to it (yes, even taking a patient to a room has a clinical element to it), and the PFPs are supposed to be only in charge of administrative tasks.

Confusing to you no doubt....think of how I feel. They want this list by next week (right....) but I'm at a dead end aside from stocking the rooms and ordering supplies.

Can anyone help me out here? Anyone ever been in a similar situation??? How do I convince the docs that I don't hate MAs but am just trying to do what my NPA and BoN say I can do. I don't want to lose this job, but I don't want to lose my license, either.

Thanks for whatever help you can give!!!!!!! :o

[suzanne4, RN]

There is no reason that they can't handle patient flow, but absolutely not relaying a physician order to you, that you would be responsible for. I legally would not accept a verbal order from the MA, it must come from the physician with you hearing it. If she gets it wrong, it is your license on the line.

Explain to the phycian, that the MA may operate under the physician's license, you are working under your own license and do not want to lose it.

From a legal standpoint, unless that order is written by the physican, and handed to me by the MA, I would not follow it. A verbal order from the MA is a legal no-no.

[Jolie, BSN]

Well said, Suzanne!

[Spritenurse1210, BSN, RN]

I worked in an office as an MA, where this was the case. it was a fairly small office; one doc, one RN 2 MA's, 2 receptionist, one file clerk and an office manager. The office manager (satan spawn) had deligated the other MA as the Charge Person. I will not give her the dignity of the title of nurse (i will be a nursing student starting fall 2006). She was in charge of everything (due to her tenure). In fact when i spoke to the office manager about the fact that she was OVER the RN who had THIRTY YEARS of experience, i was basically told to mind my own business. I am licensed as a CNA/MA (CNA in maryland, virginia, and west virginia, National certification as an MA).the scary thing thing is, SHE WAS NOT EVEN LICENSED TO PRACTICE AS AN MA OR CNA OR ANYTHING IN THE STATE OF MARYLAND!!!!!!!!!!! She didn't even have the desire to be licensed nor the desire to do anything but be queen bee of the office, and sit on her big butt barking orders, drinking lattes and filling out papers all day. needless to say i quit ASAP.

[Kim O'Therapy, BSN, RN]

Dear Bree,

I am still nursing student; however, I currently work as an aide in an outpatient clinic (located inside of a hospital). Since you are the clinical manager, wouldn't it be your decision? The unit I am on has all nurses and aides supervised by the unit manager (a nurse). All secretarial, scheduling, and clerical staff answer to the business manager. I don't know how busy your clinic is, but ours can get pretty swamped! I call the pt. into a partitioned area and take their vitals and enter them into our computer system. I do NOT attempt to assess, nor do I do an allergy hx - the nurses must do that. Then, the pt. goes back to the waiting room until the nurse calls them. Our RNs and NPs love that because they may then focus on assessments and phone calls, also, the pts. like it because they get some attention while waiting.

Good luck!

[CarrieH]

I'm a CMA (certified medical assistant). As far as I know, MA's are not part of the nursing hiarchy and therefore work directly under the supervision of a doctor or nurse practitioner. They are trained especially to work in an office and I've seen many MA's that are office managers, but none that are "nursing superviors." In fact, they should not be referred to as "nurses" in any form (and believe me, I've gotten in lots of arguments at work over that issue).

I have worked side by side with nurses without any problems because I repect their training and they respect mine. 4 years ago I worked in a single doctor practice and was one of two CMA's with no nurses and therefore managed myself. Now I'm working in a multi-doctor practice and an LPN is the nursing supervisor over 3 MA's and a phlebotomist.

At one point I was sort of a supervisor over RN's for a couple of months, but those RN's were temps, the place was going under, and I was the last full-time clinical staff person left. Even then, I was basically in charge of everyone's hours and who worked with what doctor. At no time did I tell an RN what to do as far as taking vitals ect. They still answered to the doctors.

Our office has tried to institute a "flow manager" system that we all take turns doing, but it doesn't always work out so well because we're all too busy to keep track of everybody. For the most part, when the LPN is on duty she is the "flow manager". When she's not, I take turns with another CMA who has worked at this office for a long time. Keep in mind that in our office, the "flow manager" is also taking in patients, doing EKG's, PFT's, Veni's, shots, calling in refills, ect at the same time. None of us does it exclusively.

You might want to try something similar in your office. I don't know if your MA's ever work without a nurse on duty at the same time. Please don't write the MA's into a corner and limit them too much. They can be a great asset if you let them. They might be most useful to you as "floaters" who go where you need them. (Go behind you and do the shots, veni's, ect. while you manage the flow).